Pancreatic iron and fat assessment by MRI-R2∗ in patients with iron overload diseases

Charlotte D. Pfeifer, Bjoern P. Schoennagel, Regine Grosse, Zhiyue J. Wang, Joachim Graessner, Peter Nielsen, Gerhard Adam, Roland Fischer, Jin Yamamura

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background To determine the pancreatic iron (R2) and fat content (FC) in comparison to hepatic and cardiac R2∗ in patients with iron overload disorders like β-thalassemia major (TM), Diamond-Blackfan anemia (DBA) or hereditary hemochromatosis. Methods R2∗ rates were assessed in the liver, heart and pancreas of 42 patients with TM, 29 subjects with other iron overload diseases, and 10 controls using an ECG-gated breathhold sequence (12 echo time [TE]=1.3-25.7 ms, readout repetition time [TR]=244 ms). Pancreatic R2∗ and FC were assessed from TE dependent region of interest based signal intensities performing water-fat chemical shift relaxometry and were compared with laboratory parameters (glucose, HbA1c, amylase and lipase). Results A pancreatic iron gradient from tail (R2=122 s<sup>-1</sup>) to head (R2=114 s<sup>-1</sup>, P<10<sup>-4</sup>) was found. The close association between cardiac and pancreatic R2∗ was also confirmed in patients with TM and other iron overload diseases (r<inf>s</inf>=0.64, P<10<sup>-4</sup>). Receiver operator characteristic analysis (area: 0.89, P<10<sup>-4</sup>) identified patients with elevated cardiac iron at a pancreatic R2∗ cut-off level of 131s<sup>-1</sup> (sensitivity=specificity at 81%). Highest pancreatic R2∗ (211s<sup>-1</sup>) and FC (36%) were found in the tail region of diabetic patients with TM. Conclusion Pancreatic tail showed highest R2∗ rates and fat contents, especially in patients with thalassemia. Besides iron accumulation fatty degeneration might be an additional risk factor for the development of diabetes in β-thalassemia major, but this hypothesis needs further studies in prediabetic patients.

Original languageEnglish (US)
Pages (from-to)196-203
Number of pages8
JournalJournal of Magnetic Resonance Imaging
Issue number1
StatePublished - Jul 1 2015


  • fat infiltration
  • iron overload
  • pancreas
  • pancreatic tail
  • R2
  • thalassemia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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